Common skin problems in newborns

Caring for skin from birth to 18 months

Two skin problems seen in babies are so common we’ve given them their own pages: click on the following links for information about baby acne and nappy rash.

Many of the skin problems seen in toddlers are also seen in babies. Read about conditions which commonly affect toddlers.

Birthmark on a newborn palm. Image: Marc Levin (mil8) on FlickrBirthmarks – blemishes or markings on a baby’s skin on any part of the body. The two most common types are known as port-wine stains, which are present at birth, and hemangiomas, which can appear later on. Birthmarks may change over time, growing with the child or fading. While usually harmless, some people find birthmarks unflattering and opt to minimise their appearance with corticosteroid medications or pulsed-dye laser treatment.

Cradle cap in a 2 month old. Image: LepoRello on Wikimedia commonsCradle cap - a form of seborrheic dermatitis which presents as a thick, yellow or brown crust on the scalp of infants. Other symptoms include greasiness, flaky or reddened skin. Cradle cap is caused by inflammation of the sebaceous (oil-producing) glands which are stimulated by the mother’s hormones in utero. Despite its unpleasant appearance, cradle cap is usually harmless and typically resolves without treatment by three months of age.

Spreading, irritating or persistent cases may represent other dermatoses, such as atopic dermatitis. In addition, the skin beneath the crust can occasionally become infected. In such cases, further medical treatment may be required. Home remedies for minimising cradle cap include massage with mineral oil to loosen scales, followed by shampooing hair and removing the crusts with a soft toothbrush. Mild anti-dandruff shampoos containing salicylic acid may also improve the condition.

Eczema - refers to a range of conditions which involve skin inflammation, the most common of these being atopic dermatitis. Atopic dermatitis is characterised by an itchy, red rash which most commonly appears on the face and scalp. The condition usually appears in a child’s first year of life and may be dry, scaly, blistered, weeping, bleeding or warm to the touch.

Atopic dermatitis is a complex disease and, although its precise cause is unknown, various genetic and environmental factors are believed to be involved. As a result, children who have a family history of allergy or dermatitis are more prone to developing this type of dermatosis.

Atopic dermatitis is characterised by an itchy, red rash which most commonly appears on the face and scalp.The itchiness of atopic dermatitis can be extremely aggravating, to the extent that it may interfere with a child’s sleep or other daily activities. Babies or children will often try to scratch or rub their affected skin against clothing and objects to alleviate this irritation. It is important to discourage children from scratching their skin as this may cause it to become infected. Some parents find that closely cropping fingernails helps to minimise the damage caused by scratching in younger children; babies may also benefit from wearing ‘scratch mitts’ or being tightly swaddled during their sleep.

Most cases of childhood atopic dermatitis are mild and the vast majority of these outgrow the condition. Unfortunately, a small proportion of people have a moderate to severe condition which persists into adulthood.

Atopic dermatitis is a chronic condition which needs to be continually managed and monitored. It is typical for atopic dermatitis to improve or flare up intermittently, sometimes in response to allergens or other environmental triggers. There are, however, some simple measures you can take to relieve some of your child’s discomfort: regularly (twice daily) apply an emollient, these products smooth the skin and may help to ease the itchiness; dress them in soft clothing; keep them cool where possible; avoid exposure to known allergens or triggers; wash their clothes in mild detergents and bathe them with gentle fragrance-free soaps or soap-free cleansers.

It is important to see a qualified physician to accurately diagnose your child’s skin condition, they will be able to give lifestyle advice and prescribe an appropriate treatment plan.

For more information on symptoms, causes and treatment options, refer to the atopic dermatitis article on our Science of Skin website.

Erythema toxicum neonatorum – a skin condition which occurs in more than half of all newborns. It presents as red blotches with little white bumps in the centre and it typically occurs within the first few days or weeks. The rash is common on the face and torso, and appears less often on the arms and legs.

With its cause unknown, the appearance of erythema toxicum can be distressing for new parents, however, it is important to realise that it is totally harmless. A pediatrician can easily diagnose the condition by examining the baby’s skin and the rash usually resolves after several days to weeks without treatment; it is exceedingly rare for it to continue beyond four months of age.

Heat rash (prickly heat or summer rash) – emerges as tiny red bumps on areas of the body which get hot and sweaty; these can become itchy. It often occurs on parts of the body covered with tight or warm clothing such as the neck, chest, tummy, bottom or groin during summer.

Heat rash is caused by your baby overheating and sweating too much. The excess sweat clogs their pores and produces a rash. It is usually only a minor ailment, but heat rash is a signal that your baby is getting too hot, which can potentially develop into life-threatening conditions like heat stroke.

It is important to cool your baby down; this may involve removing some layers of clothing, moving the child to a cooler place or using a fan or air conditioner to direct a gentle breeze near the baby. A tepid bath, or sponging the baby gently with a wet cloth, and letting them dry off can also help to lower their temperature.

Remember that the aim is to return the baby’s skin to a normal temperature range, not to make them suddenly cold, as this can have dangerous consequences of its own. In hot weather it is best to dress your baby in lightweight clothing made of natural fabrics (i.e. cotton).

A newborn under ultraviolet for jaundice. Image: Andrew in Durham on FlickrJaundice – a yellow tinge to the skin caused by an accumulation of the pigment bilirubin in the blood. Bilirubin comes from the break-down of red blood cells and its takes a little while for a baby’s liver to adjust to properly processing it.

Over half of full-term, and nearly all pre-term, babies have jaundice to some degree; usually appearing in their 2nd to 5th day. Jaundice is normally a mild condition which disappears without intervention within a few weeks. As long as the baby is feeding frequently (8 to 12 times per day initially), their bodies will be able to remove the extra bilirubin in their stools.

Very occasionally, in cases of severe jaundice, the elevated levels of bilirubin can cause damage the baby’s brain and nervous system called kernicterus. Left untreated, this can lead to deafness, developmental problems, mental disability, and even death. Phototherapy is deemed the safest and most effective treatment for jaundice - the baby is laid under blue lights which emit a specific range of ultraviolet light. This type of light transforms the bilirubin into a form with which the baby’s body can more easily cope.

Milia - baby acne is often confused with milia; tiny ivory-coloured bumps on the cheeks, nose and chin of infants. Milia are less prominent than acne and do not become red or inflamed. They are caused by shedding skin cells which clog pores and are often present from birth or shortly afterwards. As with baby acne, milia usually subside unaided within a few weeks

References

American Academy of Dermatology, n.d, ‘Birthmarks’, retrieved 19 July 2011, <http://www.kidsskinhealth.org/grownups/birthmarks.html>.

American Academy of Dermatology n.d., ‘Eczema’, retrieved 11 July 2011, <http://www.aad.org/skin-conditions/dermatology-a-to-z/atopic-eczema>.

BabyCenter 2011, ‘Heat rash’, retrieved 19 July 2011, <http://www.babycenter.com.au/baby/health/heatrash/>.

The Children’s Hospital at Westmead 2010, ‘Jaundice in newborn babies’, retrieved 4 July 2011, <http://www.chw.edu.au/parents/factsheets/jaundice_in_babies.htm>.

Clinuvel Pharmaceuticals n.d., ‘Atopic Dermatitis’, retrieved 11 July 2011, <http://www.clinuvel.com/skin-conditions/common-skin-conditions/atopic-dermatitis>.

Department of Dermatology, St. Vincent’s Hospital Melbourne 2002, ‘Erythema (Toxicum) Neonatorum’, retrieved July 19 2011, <http://www.dermatology.svhm.org.au/MCH/MCH%20Erythema%20Neonatorum.pdf>.

The Royal Children’s Hospital Melbourne 2007, ‘Kids health info for parents: Cradle Cap’, retrieved 11 July 2011, <http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=11053>

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